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Trust Board 5 April 2016 Minutes of 2 February 2016

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of 15 Chair’s Initials

Minutes of the Meeting of the Trust Board of Northern Devon Healthcare NHS Trust

Held in the Chichester House Boardroom at North Devon District Hospital on Tuesday 2 February 2016

PRESENT

Dr Alison Diamond Chief Executive Dr Tim Douglas-Riley Non-Executive Director Mr Robert Down Non-Executive Director Mr Roger French Chairman Mrs Pauline Geen Non-Executive Director Mr Nick Lewis Non-Executive Director Mr Tony Neal Non-Executive Director Mr Andy Robinson Director of Finance and Performance Dr Nicola Ryley Director of Nursing Mr Robert Sainsbury Director of Operations Dr George Thomson Medical Director

IN ATTENDANCE

Mr Darryn Allcorn Director of Workforce and Development Andrea Bell Assistant Director of Nursing (for Item 008/16) Jonathan Broad Associate Non-Executive Director Mr Andy Ibbs Director of Strategy and Transformation Gemma Lilley Ward Sister, Lundy (for Item 008/16) Mrs Clare Luxton Temporary PA to the Director of Operations and Director of Strategy and Transformation Mr Iain Roy Director of Facilities

001/16 Chairman’s Remarks

The Chairman welcomed Tony Neal, Non-Executive Director and Jonathan Broad, Associate Non-Executive Director to their first Board meeting since their appointment.

002/16 Apologies

Apologies were noted for Keri Storey, Assistant Director Health and Social Care.

003/16 Register of Interests

The Register of Interests for Quarter 3 2015/16 was presented. The Chairman noted that since the end of Quarter 3, there had been two changes to the Board. Tony Neal had been appointed as Non-Executive Director and Jonathan Broad had been appointed as Associate Non-Executive Director. It was noted that the Live Register of Interests on the Trust’s website had been updated with these changes.

The Chairman asked if there were any new notifications to note for the Register of Interests.


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The Chairman advised that he had been accepted as a Trustee of North Devon Hospice with effect from 1 March 2016.

Jonathan Broad advised that he was Chair of Governors, Ashleigh Primary School. NEW Devon Clinical Commissioning Group, Lay Member Clinical Policy Group, Academic Health Science Network South West, Medicines Optimisation Chair and Lay Advisor. He also advised that he was in a Personal relationship – Partner member of staff at Northern Devon Healthcare NHS Trust

Tony Neal advised that he was a Director of Bright Thought Consulting, Chair of Governors, Hayward’s Primary School and a Governor, Bow Community Primary School.

George Thomson advised that his previously declared interest as a Director and Owner of Panacea-Global (Ltd) should be removed from the Register and that of his spouse.

Robert Down advised that he was a Non-Executive Director of North Devon Homes Trading Limited (formerly North Devon Homes Developments).

The Board NOTED the updates and RECEIVED the Register of Interests for Quarter 3 2015/16.

004/16 Minutes of the Meeting held on 1 December 2015

The draft minutes of the meeting held on Tuesday, 1 December 2015, numbers 169/15 to 194/15 were considered and the following amendments were requested:

Page 5 of 29, third paragraph from the bottom should read: “It was noted that Nick Lewis, Children Safeguarding Champion, does already undertake this training”.

Page 21 of 29, the final two sentences of the paragraph starting ‘Robert Down…’ should be removed: “However, the findings of the auditors are not disputed. Nick Lewis added that there were some of the actions for this audit which were disputed”.

Subject to the above amendments, the Board APPROVED the minutes of the meeting held on 1 December 2015.

005/16 Matters Arising

The Board reviewed the Action Grid attached to the minutes and noted the following updates: Action 12 – 189/15 – National Inpatient Survey The Board noted that the action had been undertaken and was complete. Action complete. Action 6 – 178/15 – Integrated Performance Report The Board noted that the evidence base for monitoring cardiac output had been looked into and it was noted there was NICE guidance for monitoring cardiac output. The CQUIN no longer existed. NICE had not updated its recommendations and therefore the Trust was being marked as “red”. George Thomson advised that he would ask the Anaesthetists to stop monitoring cardiac output as the Trust would always appear “red”. Alison Diamond suggested the Lead Anaesthetist presents a brief report to the Quality Assurance Committee, for explaining the reasons for this change. Action ongoing.


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Action 5 – 176/15 Patient Story The Board noted that there had been a targeted communication around the high use of translation and interpretation services in the Trust. This had also been raised with the Patient Management Team. It is now part of Customer Care training and information had been made available for the hospital Switchboard staff to alert them. It had also been raised at the Ward Manager’s Forum and Senior Nurse Forum and would shortly be available on the Trust’s Intranet system, BOB. Action complete. The Board NOTED the matters arising and AGREED the updated actions on the Action Grid.

006/16 Chairman’s Report February 2016

The Chairman advised he did not propose to go through each of the items noted in his report but asked if the Board had any questions they wished to raise.

There were no questions raised and the Board RECEIVED the Chairman’s Report for February 2016.

007/16 Chief Executive’s Report February 2016

The Chief Executive presented her report for February 2016. The Board noted the following:

Community Services in Eastern Devon

A huge amount of work had been undertaken with the Northern, Eastern and Western Devon Clinical Commissioning Group and the Royal Devon and Exeter NHS Foundation Trust to draw up an implementation line with a critical decision path alongside it to enable the deadline date of 1 June 2016 for the transfer of services. The Executive Team is receiving regular updates on progress and are aware of the disruption felt by staff and how this is affecting all parts of the organisation. The Board noted that regular updates were being provided to staff.

Perfect Week

The Board noted that the Perfect Week initiative had now rolled into the Perfect Month.

Temporary Changes to ENT Services at North Devon District Hospital

The Board noted the various Flash Reports which had been sent regarding temporary changes to the ENT services at NDDH.

In addition to the Chief Executive’s Report, the Board was advised that:

CQUIN WC7 Term Admissions

At a Clinical Services Executive Committee (CSEC) meeting held on 27 January 2016, a presentation was provided showing an analysis of findings from Clinical Reviews of term admissions to the Special Care Unit and NDDH. The report outlined the following:

This had been identified as a CQUIN goal for Northern Devon Healthcare NHS Trust in 2015-16.

The overall aim of the CQUIN is to reduce separation of mothers and babies and reduce demand on neonatal services by improving learning from avoidable term admissions into neonatal units.

The CQUIN requires that for all term babies that are admitted to the neonatal unit for medical care a thorough and joint clinical review is undertaken by the maternity and neonatal service within one month of the admission.

An Action Plan had been developed and the majority of actions had been completed. A plan is required going forwards.


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The Board noted that this was being reported to Board due to timeframes. The usual process would be for presentation at the Quality Assurance Committee, but this could not happen and therefore it had been reported at CSEC where the Committee was assured it was a very robust action plan. The report would be presented to the next Quality Assurance Committee. Royal College of Physicians Falls Audit The Board was advised of an error in the original report which had been previously published. There was now an amendment on the Royal College’s website which gave a more realistic reflection of how the Trust is performing.

[Andrea Bell and Gemma Lilley arrived] Junior Doctor’s Strike The Board was advised of the announcement that there would be a Junior Doctor’s strike. It confirmed that although there had been negotiations and agreement in safety, education and training and in-hours pay, there remained an outstanding issue with regard to out-of-hours pay. However, the Board noted that further to the original announcement, emergency cover would now be maintained. Plans would be put in place as per previous strike arrangements to ensure that patient safety is maintained. Assistant Director Health & Social Care The Board noted that this would have been Keri Storey’s last Board meeting as she was leaving the Trust to take up a post with Devon County Council as Head of Adult Social Care. On behalf of the Board, the Chief Executive thanked her for all her hard work and contribution to the Board over a number of years and wished her well for the future. The Chairman agreed to write to Keri personally. Following the report, a question was raised regarding how temporary the changes to the ENT services were, particularly with regard to how practical and likely it would be to resume the service. The Board noted that it is temporary until a final model of care is determined through the Success Regime. Pauline Geen, Non-Executive Director, wanted to understand how these changes would impact on patients. Robert Sainsbury, Director of Operations, advised that the pathway is not hugely disrupted as the Trust already has visiting support from the Royal Devon and Exeter NHS Foundation Trust. In terms of urgent pathways, the current arrangements would remain in place but would be extended to weekends i.e. all urgent patients would be transferred to the Royal Devon and Exeter NHS Foundation Trust. The Chief Executive advised that every option had been explored to sustain the current service, however due to a national shortage in recruiting senior doctors in ENT this was the Trust’s only option, and by capturing the data this would inform future models. The Board RECEIVED the Chief Executive’s Report and update for February 2016.

008/16 Patient Story

The Chairman welcomed Andrea Bell, Assistant Director of Nursing, and Gemma Lilley, Ward Sister – Lundy Ward, to the meeting to present the Patient Story. A presentation was provided on the ‘Reduction of Harm Events on Lundy Ward’ and a number of handouts were tabled. The Board noted that:

The campaign aimed to reduce avoidable harm from pressure ulcers and falls by 50% in six months and to see a reduction in un-witnessed falls reported.


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A huge amount of work had been undertaken to achieve this including: o All staff on Lundy Ward were asked to sign up to the campaign; o Held 1:1’s with all staff to gain current knowledge base; o Engaged all Consultants, Physiotherapists and Occupational Therapists. o Overcame issues regarding time, staffing and layout; o Visibility of patients; o In relation to falls, staff ensured that patients wore appropriate footwear, and were

nearby to patients when toileting or showering; o In relation to pressure ulcers, raised awareness by using pictures of pressure ulcers; o Laminated information cards were designed to attach to ID badges for pressure

ulcers; o Falls and Pressure Ulcer Groups were being set up; and o Information was shared via email, monthly newsletters, posters and at meetings.

The results following the campaign saw a reduction in falls by 62.8% and by 61.5% for pressure ulcers.

The next steps are to sustain the current figures, roll out the initiative Trust-wide and assist other wards in harm reduction and to also celebrate its success.

A new challenge has been set by the Tissue Viability Nurse to have 100 days free from pressure ulcers.

The Board discussed the various issues raised during the presentation. Robert Down, Non-Executive Director, stated that this was a major personal initiative as well as a health and safety initiative that required continual reinforcement. Nick Lewis, Non-Executive Director, asked how the impact of the patients had been managed and was advised that patients were identified as who was most at risk and those patients were put in bays to ensure visibility. However, if this could not happen a risk is recorded on the Corporate Risk Register. Robert Sainsbury, Director of Operations, was interested in how Gemma captured the team and how this could be initiated across organisations and how it could be applied in other projects. Gemma advised it required dedication at Ward Manager level to drive the campaign and to cascade it to others until it becomes second nature. The Board noted that the Ward Manager on Glossop was being supported in this campaign as the number of falls were quite high. Andrea Bell, Assistant Director of Nursing, advised that overall harm had reduced. Initially it was felt that this was a staffing issue but this campaign has showed that it’s more a change of culture rather than an additional staffing requirement. Tim Douglas-Riley, Non-Executive Director, referred to Grade 2 pressure ulcers and queried whether the focus should be on Grade 1 pressure ulcers, before they become Grade 2, and was advised that the campaign only looked at the Grade 1 pressure ulcers that progressed to Grade 2, and the majority of Grade 1’s were reversed within 21 hours. Alison Diamond, Chief Executive, suggested the length of stay of patients was investigated to see if it demonstrated a reduced length of stay as this would be a significant piece of work. In relation to not setting a zero tolerance in future, it was noted that it would be difficult to maintain progression if the target is not set at zero.


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Nicola Ryley, Director of Nursing, thanked Gemma for sharing her presentation with the Board and advised that it was also being shared within the organisation and challenge is continuing. Gemma will also share with Ward Managers and at a celebration event in a couple of months’ time. Roger French thanked Gemma Lilley and Andrea Bell for attending the meeting and for sharing these fantastic results to the Board. The Board RECEIVED the Patient Story.

[Andrea Bell and Gemma Lilley left the meeting]

009/16 Quality Assurance Committee

Tim Douglas-Riley, Non-Executive Director and Chair of the Committee, presented the minutes of the Quality Assurance Committee meeting held on 8 December and draft minutes of the meeting held on 12 January 2016. The Board noted the significant issues highlighted for each set of minutes and was asked if there were any questions arising from the minutes. 8 December 2015 The Committee had reviewed the way it functions using the Royal College of Nursing tool for effective team work and committees. It concluded that the Committee was a highly functioning Committee but that actions could use SMART principles more often, and this was something all Committee members would work towards. This exercise would be repeated in six months’ time. The Committee were taking action in relation to over-reporting Serious Incidents Requiring Investigation (SIRIs) and were assured that whilst the number of SIRIs were reducing the focus remained. 12 January 2016 The Committee had requested a Deep Dive in relation to Ophthalmology following concerns about waiting times and a number of SIRIs which had been due to delays in follow-up assessments. The Board noted that significant progress had been made and the Committee were re-assured with the results of the Deep Dive investigation. The Board RECEIVED the approved minutes of the Quality Assurance Committee meeting held on 8 December 2015 and the draft minutes of the meeting held on 12 January 2016.

010/16 Integrated Performance Report

Rob Sainsbury, Director of Operations, presented the Integrated Performance Report for Month 9 2015. The report would be presented in three sections comprising Quality, Performance, and Workforce and that Rob Sainsbury would cover Quality and Performance, with George Thomson covering Mortality within this, and Darryn Allcorn would cover Workforce.

The following key issues were highlighted from the report presented.

QUALITY AND PERFORMANCE RTT

This standard is green for December at 94.4% against a target of 92.0%.


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There was a specialty breach in Trauma and Orthopaedics in December and there is a possibility of a breach in January also. The reason for this drop in performance was due to winter pressures and capacity issues.

The December position had been compounded by the potential strike action and capacity in the elective pathway.

The Divisional Director for Planned Care and the teams are working on a recovery plan for February and March.

Overall the standard has been met. A&E

The combined A&E performance for all types is slightly below target at 94%.

The A&E 4 Hour Standard was not achieved in December for Type 1 attendances with 83.6% of patients treated within 4 hours.

Cancer

Performance against the 2 Week Cancer Standard had improved and the standard had been achieved in September, October, November and December.

The breast symptomatic standard was also achieved in November and December, but remains vulnerable.

All three 31 Day Standards achieved 100% in December.

The 62 Day Standard had been achieved for Trust managed pathways since September and for shared pathways for two consecutive months.

Early indications for January show that the Trust will be compliant. Rob Sainsbury advised the Board that a webinar with the wider NHS is being shared in relation to the improvements with the Cancer standard.

CQUINs Mortality George Thomson provided an update on mortality. Mortality Indicators

There have been four months of improvement in relation to Hospital Standardised Mortality Ratio.

This is as a result of a sequence of results that are reducing and having a significant change in performance.

A pilot is being launched of a structure case review for every death. George Thomson advised the Board that a conference call is being held with senior medical staff at the TDA and Monitor. The Trust is the only Trust in the county adopting this methodology and all Trust’s will be required to undertake it by the end of the year. As a result, the Trust is being closely scrutinised. DTT

Delayed Transfers of Care is still above target for Eastern Community Hospitals in December, with a variety of reasons being noted including awaiting nursing or residential home placement, awaiting care package, family choice or dispute.

There is an improvement with longer length of stay patients, and there are positive outcomes from the perfect week/month in relation to those patients and the indicators support this.


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In response to a query raised, George Thomson, Medical Director, advised that the Year to Date information is not measured as the run charts reflect responsibility to alert teams taking over the services to any concerns. Robert Sainsbury, Director of Operations, advised the Board that a request had been made to the Better Care Fund to separate the Eastern and Northern position. Ambulance Handovers

There continues to be a steady reduction in the number of 30 minute and one hour handover delays.

Of the 1351 ambulance handovers during December, 92 were delayed by 30 minutes. Of the 92, 39 were chargeable 30 minute delays.

Most of the pressure is from the Emergency Department, although the position is showing an improvement in January.

Robert Sainsbury, Director of Operations, advised the Board that the position isn’t reflective of the performance being delivered. The standard is being met on a daily basis, but when there is a breach it brings the weekly and monthly position to a much lower position. Work is being undertaken with the teams and in the Medical Assessment Unit to reduce flow in the Emergency Department. Alison Diamond, Chief Executive, advised the Board that a conference call has been arranged regarding A&E performance and winter planning for 2016-17due to pressure in the system. In comparison to last year she advised the Trust was in a much better position but would not have the benefit of Minor Injury Units going forwards and therefore a lot of work needs to be undertaken to significantly improve. In response to a query raised regarding the high number of attendances to the A&E Department in July and August 2014, compared to the low number of breaches, the Board noted that this was due to the types of patients attending A&E during the summer period and the types of injuries. George Thomson advised that there was a concern regarding Endocsopy Urgent Waits and informed the Board that a briefing paper and action timeline would be presented to the Board meeting in April 2016. GT WORKFORCE Darryn Allcorn, Director for Workforce and Development presented the Workforce Report. Agency

There has been a reduction in agency usage and the agency WTE percentage figure has decreased to 1.9% which is the lowest figure since April 2014.

Sickness Absence

There has been an increase in sickness absence mainly due to seasonal issues.

Particular attention is being paid on Anxiety related absence and musculoskeletal conditions, which are having an impact on long term sickness figures.

Learning is being identified as a result of the closure of Willow Ward to help avoid any sickness-related issues in future.

Appraisals

The Appraisal rate figure for December is 74.2% against a target of 85%. This remains an ongoing challenge and work is continuing with the teams.


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In response to a query raised regarding the in-month changes in sickness absence, which is always low so shows a flat line on charts, Darryn Allcorn, Director of Workforce and Organisational Development, advised the Board that he would discuss with the Performance Team whether the ranges could be changed. There was a question as to whether this should be a rolling 12 month period rather than in-month sickness percentage. It was agreed that it would be in-month which is the standard national figure and a quarterly and year end position would also be reported, which is already in the report. DA Pauline Geen, Non-Executive Director, raised a query regarding the significant number of leavers above those joining the Trust in December and was as expected from a seasonal point of view. In terms of recruitment, this figure should reverse in January. Tim Douglas-Riley, Non-Executive Director, queried whether there had been an increase in staff leaving in the East as a result of services transferring. Darryn Allcorn, Director of Workforce and Organisational Development, advised that there had not been an increase in the number of people leaving but there had been an increase in the number of people retiring. There is a joint recruitment plan underway. The Board RECEIVED the Integrated Performance Report – December 2015.

011/16 Variable Pay and Quality Report

Nicola Ryley, Interim Director of Nursing, presented the Variable Pay and Quality Report. The paper outlined the progress made during December 2015 to reduce variable pay within the inpatient wards at North Devon District Hospital. The Board noted the following:

During this time nursing establishments had been aligned to a nurse to patient ratio of 1:8, in line with NICE guidance.

In December, the Trust delivered the national agency cap, achieving 5.9% of the 6% target.

Patient safety outcomes continue to be measured. The falls rate had increased marginally and pressure ulcer performance had improved.

A review is being undertaken in Eastern Community Hospitals to look at the impact this is having on length of stay and any correlation with wards using agency.

There is a falls acuity and dependency review starting in February for four weeks and this information will be presented to the Board in April 2016. It will then be presented on a regular basis, with the aim being to demonstrate safe staffing, to review ward posts and variable pay in one report.

The Trust is supporting the “John’s Campaign” initiative which engages carers to spend time on wards with patients with dementia, which could have a positive impact on safer staffing and the irradiation of agency staff.

Alison Diamond, Chief Executive, informed the Board that variable pay updates would continue to be received at Board Briefings, and Nicola Ryley, Director of Nursing, was requested to provide the two newly appointed Non-Executive Directors a brief summary on the deep dive that was undertaken in relation to the level of agency verses harm events. NR The Board RECEIVED the Variable Pay and Quality Report.


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012/16 PLACE Assessments

Iain Roy, Director of Facilities, presented the results of the Patient Led Assessments of the Care Environment (PLACE) 2015 Results and Actions. The Board was advised that:

This is a national initiative required to be undertaken by all Trusts.

This is a self-assessment of a range of non-clinical services which contribute to the environment in which healthcare is delivered in both the NHS and independent/private healthcare sector in England.

The paper explains the process, results and key themes of the inspections and the actions proposed to ensure continuous improvement.

As part of the process all Trusts were required to include patient assessors as a fundamental part of the assessments. There were four patient representatives at the NDDH site and the Community Hospital sites had three, which included representatives from Senior Nurses, Facilities, Hotel Services and Infection Control.

The report showed that standards were improving and the recent Care Quality Commission visits provided assurance that standards are high.

Action plans have been developed following each inspection to address the issues raised.

There were three key issues: o The amount of clutter in wards and departments; o The amount of paper signs, posters staff information notices that are displayed on

view for the public; and o Dementia principles i.e. whether the premises are equipped to meet the needs of

dementia sufferers against a specified range of criteria.

The paper was presented to the Clinical Services Executive Committee in November 2015.

The Board discussed the process of the PLACE Assessments and was advised that the Trust has no control on when the assessments take place or where they visit. This information comes from the Department of Health. The Facilities Team were praised following a comment regarding the openness of the Trust in relation to the PLACE Assessments. The Board RECEIVED the report on PLACE Assessments.

013/16 Care Quality Commission Inspection Report and Action Plan

Nicola Ryley, Director of Nursing, presented the Care Quality Commission Inspection Report and Action Plan.

The Board was advised that the key points were:

The Action Plan had been developed to ensure compliance with the Care Quality Commission Fundamental Standards following an Inspection Visit undertaken in August 2015.

The Action Plan had been discussed at a Board Briefing.

Areas highlighted by the Care Quality Commission were: o Urgent and Emergency Care; o Maternity and Gynaecology; and


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o End of Life Care

There had been further discussion with the Care Quality Commission regarding the provision of having one registered children’s nurse on duty in the Emergency Department and an agreement had been reached.

Nicola advised that in terms of next steps, it is important to ensure that all of the actions are clearly embedded and there is an awareness across the organisation.

The Board was also informed that the End of Life Steering Board was now established, and there would be a future Board Briefing on maternity services.

The Board RECEIVED the Care Quality Commission Inspection Report and Action Plan.

014/16 Finance Report – December 2015

Andy Robinson, Director of Finance and Performance, presented the Finance Report for December 2015. He advised the Board that there was an error in Appendix A – Statement of Comprehensive Income and tabled an amended version.

The Board was advised that:

The Trust has been notified that the Department of Health have agreed a £2.3m local capital to revenue transfer in 2015/16 that has moved the original forecast deficit from £7.0m to £4.7m.

The year to date deficit is £6,476k adverse to plan. The most material impacts during the year continues to be the high levels of Agency staff and slippage in year to date CIP.

Control actions have been taken to remove year to date under-spends with assessments made by directorates on the impact over the remainder of the financial year.

It is expected there will be an increase in revenue costs for business cases for future developments, as it will not come from capital.

The Trust has applied for a loan application to support the £4.7m deficit, applied for a permanent change or short term loan which will be assessed by the Department of Health in early February. If an agreement is not successful it will go through ITF which is a more lengthy process.

The Board RECEIVED the Finance Report for December 2015.

015/16 Audit and Assurance Committee

Nick Lewis, Non-Executive Director and Chair of the Audit Committee, presented the draft minutes of the Audit and Assurance Committee meeting held on 8 December 2015. The Board noted that:

The Chair of the Committee had expressed his concern regarding management responses not being at the expected standard and was given assurance that an Action Plan would be presented at the next Committee meeting.

There had been issues raised around cancellation of various Committee meetings and the Committee was advised that these were isolated incidences and all had good reasons to cancel.

In response to a query raised regarding the Reference Cost Audit, the Board was advised that this is something that is externally commissioned.

The Board RECEIVED the draft minutes of the Audit and Assurance Committee meeting held on 8 December 2015.


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016/16 Board Assurance Report Quarter 3 2015-16

Andy Ibbs, Director of Strategy and Transformation, presented an update on progress of the Board Assurance Report Quarter 3 2015-16 as at the end of the third quarter. The Board noted the key issues highlighted from the report presented:

There has been some slippage against some corporate objectives over the quarter.

The Risk Heat Map shows the risks cores for each strategic objective for Quarter 3. There has been no change since Quarter 2 2015-16.

The Board discussed the use of colours being different to those used by the Care Quality Commission in relation to whether actions were green i.e. on track, or blue i.e. complete. There had been some slippage in terms of objectives being completed. However, a great deal of progress had been made, particularly on the Operational and Workforce Development objectives, as well as Mortality and Clinical Networking. Nicola Ryley, Director of Nursing, advised that the Quality Improvement Strategy is being reviewed and refreshed. Alison Diamond, Chief Executive, advised the Board that it is important to recognise that this is an annual cycle, and things very often change throughout the year with regard to key risks and developments. There needs to be recognition that if something ceases to be relevant there is a process to replace it with something else. Alison also raised a concern regarding the development of Community Hubs, which requires a Commissioning Strategy but that the Trust won’t get until the work being undertaken by the Success Regime commences. This would determine the landscape and the Trust’s Programme of Work for the next year, as well as what is important and required. The Board RECEIVED the Board Assurance Report Quarter 3 2015-16.

017/16 Emergency Planning – Statement of Readiness

Robert Sainsbury, Director of Operations, presented the Emergency Planning – Statement of Readiness. The Board was advised of the key issues:

In response to the recent terror attacks which took place in Paris in November 2015, Dame Barbara Hakin, National Director: Commissioning Operations for NHS England, wrote to all Trusts requesting the Trust provide a statement of readiness to their Trust Board.

The letter requested that all NHS Trusts review their arrangements to support a response to an emergency.

Following a review of the Trust’s existing arrangements to support its emergency preparedness, resilience and response, the Board was advised that:

The Trust has robust arrangements in place for contacting staff during a significant / major incident and this was last tested, in full, as part of Exercise Pluto on 3rd February.


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The Trust is satisfied that it can still respond to wither a significant / major incident, event when there may be disruption to the transport infrastructure.

The Trust has arrangements in place to increase its critical care capacity, as set out in its Influenza Pandemic Plan.

The Trust has given due consideration as to how specialist advice can be sought in relation to the management of a significant number of patients with traumatic blast and ballistic injuries and would seek this advice through the NHS England On-Call system.

Robert Sainsbury, Director of Operations, advised that the Trust’s Emergency Plan had previously been ratified by the Board, NHS England and also by Neil Vine, Head of Emergency Planning Resilience and Response, at NHS England. The Board RECEIVED the Emergency Planning – Statement of Readiness.

018/16 Workforce and Organisational Development Committee

Pauline Geen, Non-Executive Director and Committee Chair, presented the draft minutes of the Workforce and Organisational Development Committee meeting held on 15 December 2016.

The Board noted the key issues highlighted from the minutes presented were:

The Committee had noted that Nurse Revalidation would commence on 1 April 2016. There was a significant risk to the Trust as lapsed revalidation would now take three months as opposed to the current 24 hours. The Director of Nursing had been asked to provide assurance that a robust process was in place.

The Committee had discussed the three days’ planned industrial action by junior doctors which had been called off at the last minute, and had noted the possibility of further industrial action.

The Committee had received feedback from Staff Engagement Events. A Listening into Action event had been planned as a result of some of the feedback received.

The Committee had noted that the Hotel Services Management of Change had been submitted to the Partnership Forum and agreed the consultation would commence in early January 2016.

In response to a question raised regarding the consequences of a nurse not being revalidated, the Board was advised that this would result in the nurse not being able to work. The Trust has put in a project management around revalidation with the aim of ensuring that everyone is ready for that process. In terms of assurance, Nicola advised that she is confident that the Trust has arrangements in place for revalidation of nurses.

The Board RECEIVED the Workforce and Organisational Development Committee draft minutes of 15 December 2016.

019/16 Emerging Issues

The Chairman asked if there were any emerging issues members of the Board wished to raise. Junior Doctors Strike George Thomson advised the Board that, until negotiations are complete it is not clear how much the proposed actions would impact financially on Trusts.


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In response to a question raised, Alison Diamond informed the Board that the Trust has no set statement in relation to the strike and the response given would be that it is supportive of anything that improves patient safety. George Thomson advised that the Medical Advisory Committee had written to Junior Doctors and indicated that senior medical staff respected their concerns and their right to take action, whilst ensuring that safe patient care is maintained. Continuing Health Care Tim Douglas-Riley, Non-Executive Director, raised a query regarding GPs looking after patients in care homes. Robert Sainsbury advised the Board that the Trust is working with the Northern, Eastern and Western Devon Clinical Commissioning Group to establish what opportunities there are for changing the way medical cover is provided. The Trust is actively involved in that and how it can support GPs in a proactive way.

020/16 Questions from Members of the Public

There were no members of the public present.

021/16 Date of the Next Meeting

The next meeting of the Trust Board will take place at 10.00 a.m. on Tuesday 5 April 2016 in the Chichester Boardroom, North Devon District Hospital, Barnstaple.

022/16 Exclusion of Press / Public

It was formally MOVED by Alison Diamond and, SECONDED by Nick Lewis and unanimously RESOLVED that under the provision of Section 1, sub-section 2, of the Public Bodies (Admission to Meetings) Act 1960, that the public be excluded from the confidential section of the meeting on the grounds that publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted.


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ACTION LOG AS AT 4 FEBRUARY 2016

No Minute Item Action Comments Lead Outcome

1 December 2015

1 176/15 Patient Story Executive Directors to discuss what actions needed to be put in place and who should lead implementation of actions to address the issues raised in the patient story regarding consent, communication, use of interpretation services.

Dec 15 – This will be taken forward by the Interim Director of Nursing and the Director of Workforce and Development linking the Trust’s values, valuing diversity. Feb 15 – Information has been made available for various staff members/groups in relation to translation/interpretation services. It is now included in Customer Care training and will be available on BOB.

NR/AD Closed

2 178/15 Integrated Performance Report

Cardiac Output Monitoring – Evidence for the process and whether the percentage the Trust is aspiring to is correct to be looked at by lead medical staff to ascertain the true benefits and for which cohort of patients. To be discussed further at Quality Assurance Committee.

Dec 15 – This will be added to monthly reporting to the Clinical Services Executive Committee. The Medical Director will also discuss with anaesthetists. Feb 15 – Anaesthetists would be asked to stop monitoring cardiac output as the Trust would always appear as “red”. A briefing report to be presented to the Quality Assurance Committee to explain the reasons for this change.

GT Ongoing

3 189/15 National Inpatient Survey

Due dates in the action plan to be reviewed (currently all due at end of March 2016) to ensure they are completed, as the next National Inpatient Survey is already underway.

Dec 15 – Work is ongoing on the current National Inpatient Survey. Feb 15 – Action has been undertaken and is complete.

NR Closed

2 February 2016

4 010/16 Integrated performance Report

A briefing paper on Endoscopy Urgent Waits to be presented to the Board meeting in April.

GT/RS

5 010/16 Integrated Performance Report

DA to discuss with the Performance Team whether the ranges can be changed in relation to in-month sickness

DA

6 011/16 Variable Pay and Quality Report

Briefing to be provided for Jono Broad and Tony Neal on the deep dive undertaken in relation to the level of agency vs harm events.

NR

Chair’s Signature …………………………………………………. Date ………………………………………………………………...

trust board 5 april 2016 minutes of 2 february 2016 minutes of … · 2019-04-27 · trust board 5...

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